After a trip around the country, Philip Alston, the United Nations’ special rapporteur on extreme poverty, was shocked by what he found.

Philip Alston has seen a lot of miserable living conditions in his work as the United Nations’ special rapporteur on extreme poverty. But what he witnessed on a recent fact-finding trip around the United States still disturbed him. The U.S. is supposed to be a rich and advanced country and yet 40 million people in the country now live below the poverty line. And–as Alston found–many Americans don’t even have access to basic sanitation and healthcare.

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In rural Alabama, he stood over open sewers a few feet from people’s homes. Parts of the state are seeing the first outbreak of hookworm–a blood-eating parasite that invades the body on contact with feces, common in the developing world–in decades. In West Virginia, he saw men and women who have lost all their teeth because there are no dental care programs for the very poor. In L.A. and San Francisco, he found persistent homelessness in some of the most economically productive cities in the world.

[Image: MariaArefyeva/iStock]“In the lead up to my visit to the U.S., my team and I spent considerable time researching the state of poverty and human rights in the United States,” Alston tells Fast Company. “I was still deeply shocked.”

Alston, a tall Australian academic with a professorship position at New York University, was invited to the U.S. by President Obama before the invitation was renewed by the Trump administration (to the surprise of some). His two-week tour in December took him to California, Alabama, Georgia, Puerto Rico, West Virginia, and Washington, D.C.

“American exceptionalism was a constant theme in my conversations,” Alston writes in an initial statement of his findings (a full report is due next summer). “But instead of realizing its founders’ admirable commitments, today’s United States has proved itself to be exceptional in far more problematic ways that are shockingly at odds with its immense wealth and its founding commitment to human rights.”

[Image: MariaArefyeva/iStock]The statement lists lots of ways the U.S. is falling behind the advanced world. Average life expectancy is falling for the first time since 1993. The U.S. ranks 36th in the world for access to water and sanitation. We rank 35th out of 37 richer countries for poverty and inequality. Our incarceration rate–about five times the OECD average–saps economic opportunity, reduces turnout in elections, and hides poverty from view, Alston says. (The poverty line is about $24,000 a year for a family of four; 18.5 million Americans have family income of only half that.)

Asked why poverty is higher in the U.S. than in other richer countries, Alston blames “caricatured narratives” about the rich being industrious, entrepreneurial, and patriotic, while the poor are “wasters, losers, and scammers.” He wonders if politicians who repeat such narratives have actually visited poor areas or spoken to anyone there. He questions why a society would look down on people who’ve been “thrust there by circumstances largely beyond their control” including by disabilities, divorce, illness, old age, unlivable wages, or job market discrimination.

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Alston’s poverty-inequality tour comes at a time when Congress is about to pass a tax bill that many economists think will make the problem worse. The bill includes permanent tax cuts for corporations and pass-through businesses, while leaving payroll taxes and most tax credits aimed at the poor alone. It also leaves a $1 trillion hole in the public deficit, according to non-partisan analysis, which could increase pressure to defund the safety net when Congress returns next year.

Along with other richer countries, the U.S. has seen a big increase in inequality in the last few decades. The share of wealth going to the top 1% of earners has risen from 22% in 1980 to 39% in 2014, according to the recently published World Inequality Report. Most of that wealth has gone to the top 0.1% of earners, some of whom have been calling on Republican lawmakers to make further tax and benefit cuts. The report, led by French academic Thomas Piketty, calls for more progressive tax rates, a global register of financial assets as a way to stop tax evasion, and more public investment in education and healthcare.

[Image: MariaArefyeva/iStock]Alston says the Republican tax package “is essentially a bid to make the U.S. the world champion of extreme inequality.” But it’s only part of a wider problem. Local governments increasingly lack the resources to take on social problems in their areas because taxation has been demonized as “inherently evil” and “legislature[s] effectively refuse to levy taxes even when there is a desperate need.”

Thus, he expects extreme poverty, with its hookworm outbreaks and toothless mouths, to get worse over time. “Given the extensive and, in some cases, unremitting cuts that have been made in recent years, the consequences for an already overstretched and inadequate system of social protection are likely to be fatal for many programs, and possibly also for those who rely upon them,” Alston says.

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About the author

Ben Schiller is a New York staff writer for Fast Company. Previously, he edited a European management magazine and was a reporter in San Francisco, Prague, and Brussels.